As a surgical resident in the 1980s, we were introduced to the age-old dictum that ‘surgery is a last resort’ that is to say that even for people who will make a living by performing surgery as surgeons, we must exclude the feasibility of non surgical treatment before embarking on surgery, because surgery, every surgery, has a complication. That meant that in our examinations even if we were presented with a condition that the obvious treatment would eventually be surgery, we must begin our answer with, ‘having excluded non surgical treatment options ------‘. In emergencies the same rule applied for a different reason, the patient must first be resuscitated to correct metabolic and physiological insults to the body systems (except in a be a handful of conditions, and even then resuscitation will carry on pari pasu with the surgical intervention, e.g. ruptured aortic aneurysm).
So when we read the article that we share below in our centre, courtesy of Reuters and the Royal College of Surgeons Edinburgh website, we noted another reason why we must not rush to surgery if there is / are other options, especially in LMICs where the public is not very aware of the risks of surgery and would often coarse the practitioners to choose the surgery option first. To make matters worse patients in LMICs present late for care because of poverty, ignorance and weak health systems and therefore are more prone to major surgery:
August 7, 2019 / 11:40 PM / a day ago
Major surgeries linked to small decline in mental functioning in older age
(Reuters Health) - Major surgery may be tied to a small decline in cognitive functioning when we are older - equivalent, on average, to less than five months of natural brain aging, a new study suggests.
“Our data suggest that, on average, major surgery is associated with only a small cognitive ‘hit,’” said Dr. Robert Sanders, an assistant professor in the department of anesthesiology at the University of Wisconsin, Madison, and the study’s senior author. “And while there was a doubling in the risk of substantial cognitive decline, this only affected a small number of patients. Nonetheless, this small potential for harm should still be considered when weighing the proposed health benefits of surgery during informed consent.” [...]
SOURCE: bit.ly/2NtjUjV The BMJ, online August 7, 2019.
AFRICA CENTRE FOR CLINICAL GOVERNANCE RESEARCH & PATIENT SAFETY
@Health Resources International (HRI) WA.
National Implementing Organisation: 12-Pillar Clinical Governance
National Implementing Organisation: PACK Nigeria Programme for PHC
Publisher: Medical and Health Journals; Books and Periodicals.
Nigeria: 8 Amaku Street, State Housing & 20 Eta Agbor Road, Calabar.
Tel: +234 (0) 8063600642
Website: www.hriwestafrica.com email: email@example.com ; firstname.lastname@example.org
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.
Email: jneana AT yahoo.co.uk